MMA, Boxing or Kickboxing Event Detail Form

Your request will be processed in the order it was received, all items must be received at least 7 business days before the event is held.

Please contact the Iowa Division of Labor if you have questions or concerns.

Basic Information

Promoter Name

Promoter Contact Name

Title

Promoter Contact Information

Venue Information

Event Address

Weigh-In Details

Weigh-In Location

Medical Information

Physician Information

Title

Licensing Information

Licensing Information
Has the Physician previously submitted Licensing Information to the Iowa Division of Labor?
One file only.
256 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Medical Service Provider

Please provide the name of the medical service provider.

Medical Service Provider Contract Information

One file only.
50 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

EMT Name(s)
Title
more items
Provide the name of the assigned EMT(s) for this event.

Security Information

Security Firm Name

Security Firm Contact

Title

Security Firm Contact Info

Security Firm Contract

One file only.
256 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Cleaning Services

Cleaning Service Contact

Cleaning Service Representative

The person responsible for cleaning between rounds.

Cleaning Service Rep Phone Number

Insurance and Bond Information

Insurance Information

A copy of the insurance policy and claim form should be provided.
One file only.
256 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.

Bond Information

Evidence of a $5000.00 bond must be provided.
One file only.
256 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.

Other Information

Please attach any other information and/or documentation you find necessary with your application.
One file only.
256 MB limit.
Allowed types: gif, jpg, jpeg, png, pdf.